Individuals, Populations & Clinical Practice Flashcards
What is the definition of population health?
population health is an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population
What is the NHS Long Term plan?
an ambitious 10-year vision for healthcare in England
over the next 10 years, health and care will change significantly
the new service model includes increasing care in the community and a focus on population health, prevention and reducing health inequalities
What are the 4 components of population health?
- the wider determinants of health
- an integrated health and care system
- our health behaviours and lifestyles
- the places and communities we live in, and with
What is the most important driver of health?
What are some examples?
the wider determinants of health are the most important driver of health
in addition to income & wealth, these determinants include:
- education
- housing
- transport & leisure
What is the second most important driver of health?
What are examples of these?
health behaviours and lifestyles
this includes smoking, alcohol consumption, diet and exercise
What is the definition of the “social determinants of health”?
it is a term used to describe the social and environmental conditions in which people are born, grow, live, work and age, which shape and drive health outcomes
What are the main examples of the wider determinants of health?
- agriculture and food
- water and sanitation
- unemployment
- social and community networks
- living and working conditions
- housing
- education
- work
What is shown in these UK population pyramids?
How has the life expectancy changed in the last 100 years and why?
over the past 100 years, england has made an escape from poor health and short life expectancy
this is largely due to improvements in the wider determinants of health, such as sanitation, improved living standards and the establishment of the welfare state
inequalities in health have persisted, but the population as a whole has seen increases in life expectancy
What is shown by the 1950 pyramid:
- having a wider base?
- being more triangular in shape?
- being shorter?
- 1950 has a wider base showing a greater birth rate
- 1950 is more triangular in shape showing a greater death rate
- 1950 pyramid is shorter showing a lower life expectancy
- overall the UK population is averagely older in 2020 than it was in 1950
How has life expectancy at birth for males and females changed in the last 30 years?
In what areas may it have declined?
- the stalling of life expectancy growth since 2011 is clear for both men and women
- for the poorest 10% of women in the UK, life expectancy has not stalled but actually declined
- the health gap between wealthy and deprived areas has grown
- living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly 5 years less
What is shown in this graph?
How is it an example of a social gradient?
it shows the relationship between local authority deprivation and healthy life expectancy at birth
on average, healthy life expectancy at birth differs by 12 years between the most and least deprived local authorities for men and women
this is a social gradient because health inequalities are only relevant for the most vulnerable or socially excluded
What is the Marmot Review?
How does this describe health inequalities?
it shows that since 2010 there have been detoriations in health and widening inequalities in England
it describes evidence showing that health inequalities do not arise by chance or simply due to unhealthy behaviour or genetic makeup
the differences in health largely reflect inequalities in the social determinants of health
How does this graph show a social gradient in health?
(obesity prevalence by deprivation in England, year 6 pupils, 2017/18)
there is a strong relationship between deprivation and obesity
severe obesity prevalence was over 4 times as high in the most deprived areas than the least deprived areas
What is the difference between equality and equity as shown in this image?
- equality would involve giving everyone the same size box to stand on to improve their lines of sight
- this involves treating everyone equally
- equity involves each person being given a box to stand on that would enable them to have a clear view over the fence
Why is the difference between health equality and health equity important to public health?
to ensure that resources are directed appropriately
for these reasons, providing the same type and number of resources to all is not enough
in order to reduce the health disparities gap, the underlying issues and individual needs of underserved and vulnerable populations must be effectively addressed
Why is it important to recognise the sociological factors that contribute to illness?
doctors need to be able to recognise the sociological factors that contribute to illness, the course of the disease and the success of the treatment and apply these to the care of patients
this includes issues relating to health inequalities and the social determinants of health and the effects of poverty and affluence
How can you understand how the social and economic factors are impacting a patient’s health?
by building a trusting and respectful relationship with all your patients and taking a full social history
then you can provide information and take action to address these
e.g. writing a support letter to housing , referring to employment programes and connecting patients to advice about benefits so that the root causes of ill health are being tackled
As a health professional, how can you be an advocate for your local community?
as a health professional, we have a strong and powerful voice to act as an advocate, not just for individual patients, but also for the community and the general population
e.g. for the COVID-19 epidemic, there is concern that vulnerable migrants who have no right to free healthcare in the UK will be at particular risk
What are the different methods of health promotion?
- medical or preventative
- behaviour change
- educational
- empowerment
- social change
What does the behaviour change approach focus on?
What is success dependent upon?
the behaviour change approach focuses on individuals - attitudes, behaviour, responsibility, choice
the success is dependent on the individual
What would be the FRAMES approach to designing an intervention to promote behaviour change?
F - Feedback:
- e.g. on the person’s risk of having alcohol problems
- cover the potential harm they may cause
R - Responsibility:
- change is the person’s responsibility
A - Advice:
- provision of clear advice when requested
M - Menu:
- what are the options for change?
- e.g. trying alternative activities to drinking, recognising personal cues for drinking
E - empathy:
- the approach is warm, reflective and understanding
S - Self-efficacy:
- the final component of effective brief interventions is to encourage patients’ confidence that they are able to make changes in their substance use behaviour
- people who believe that they are able to make changes are much more likely to do so
What is the definition of a brief intervention?
an intervention designed to promote behaviour change
What is the aim of an educational approach to health promotion?
it enables individuals to make informaed choices, by providing information and knowledge
it aims to avoid persuasion
What have recent studies shown about women from the Black and Asian Minority Ethnic (BAME) backgrounds and their likelihood to attend cervical screening?
they are less likely to attend cervical screening and GP practices wth high proportions of ethnic minority patients have lower coverage
this is putting this population at increased risk of cervical cancer and is a concerning health inequality
How has the issue that women from the BAME background are less likely to attend cervical screening been addressed?
- running regular education sessions at the GP practice for female BAME patients
- providing food and children’s activities so that having young children isn’t a barrier for attending
- having interpreters in several languages to translate and providing written information in multiple languages
- there was a lack of awareness of cervical cancer in this community and a lack of understanding about screening, which could be tackled through an educational approach
What is the definition of an empowerment approach to health promotion?
empowerment is the process of giving confidence, skills and power to individuals / communities to identify and address their concerns
Who are community health champions?
What is the aim of their work?
volunteers who establish groups to meet local needs
they draw on their own local knowledge and life experience to motivate and support family, friends, neighbours and work colleagues to take part in healthy social activities
the health champion programmes aim to address health inequalities by involving people from disadvantaged groups or those at risk of poor health
What are adverse childhood experiences?
What have UK studies seen links to?
UK studies have shown strong relationship between adverse childhood experiences and homelessness as well as early sexual behaviour, drug and alcohol use, mental health and reported suicidal behaviour or self harm
ACEs which are stressful life events between birth and 18 years of age including neglect, domestic abuse in the family, parental drug or alcohol problems
What are the different levels of factors that affect the nation’s health?
- the nation’s health is partly the result of the quality of the health or social care we receive
- it also depends on the social and economic environment in which we are born, grow up, live, work and age, as well as the decisions we make for ourselves and our families
most experts agree these are more important than health and social care in ensuring longer, healthier lives
How can health promotion & inequality be tackled at the individual and clinical care level?
- think not only about the biomedical issue of the individual patient, but also understanding the bigger picture
- helping with individual lifestyle and social issues
- e.g. working out behaviour changes for a patient drinking dangerous levels of alcohol, or referring a patient to support services
